Smart planning drives SPD
area ‘dream-worthy’ redesign efforts
by Julie E. Williamson
Before
IMS consultants redesigned this SPD, removing
clutter,
creating dedicated spaces for case carts and other equipment;
and creating uniform work stations.
After
Getting
the green light on a full department overhaul is a dream come true for
virtually any sterile processing professional, and that’s especially the
case in these days of limited resources and lingering budget constraints.
So when the opportunity
presents itself, tackling the redesign process both cautiously and
methodically is a must to ensure that the final outcome is one that
functions optimally, both now and well into the future.
"The ultimate goal for the SPD
is to ensure the accurate and on-time delivery of product that has been
cleaned, prepared and disinfected or sterilized properly," said Patrick
Down, director of STERIS Corp.’s Project Design Group. "The design of the
department needs to support that goal and anticipate future needs."
Unfortunately, some facilities
have learned that lesson the hard way, having spent a hefty sum on a brand
new or renovated department only to find that the new design still doesn’t
live up to the SPD’s expectations or meet the facility’s long-term goals.
"Renovation and redesign does
not occur often [in the SPD], so it’s important to make sure we get it
right," said Mark Duro, CRCST, FCS, central sterile processing department
manager for New England Baptist Hospital in Boston. He certainly speaks from
experience. After recently undergoing new department construction, Duro’s
spacious, fully automated department is not only the envy of many other
facilities, it’s one whose layout and functional capabilities were so
well-thought-out that virtually no stone was left unturned.
Creating such a dream-worthy
department was no easy undertaking, but as Duro explained, the hard work and
advance planning paid big dividends. "We do not have any regrets and we feel
we got it right."
Before
In the redesign of this SPD, IMS used the Lean 5S
principles to improve quality, efficiencies and workflow.
After
Go with the
flow
Among the most crucial steps
in achieving a successful SPD redesign involves carefully assessing current
workflow, and having a clear picture of the facility’s current and future
procedural volume and reprocessing requirements.
"Before you get started with
the design, you have to know the procedures you’re going to be performing
and what products will be processed," said Douglas Gayden, central region
business development director,
Getinge USA. "Only then can you determine the
best design [elements] and space and equipment requirements for the
department."
Accounting for a hospital’s
future growth and needs is paramount for maximizing the redesign investment.
"If an OR expansion is planned in the next five years then there should be a
corresponding contingency plan for expanding the SPD," reasoned Sharon
Hadley, vice president of clinical compliance and education for IMS Inc.
Experts agreed that the early
stages of design planning should involve a detailed roadmap or flowchart
that gives a clear snapshot of current processes, challenges and
bottlenecks. Creating a detailed flowchart on the life of a tray, for
example – from the time it is received in the decontamination area until it
is placed on the shelf for storage – is an important step in ensuring a safe
work environment with minimal processing steps and maximum efficiency,
according to Hadley, as is fully assessing ancillary duties performed by the
SPD, such as cleaning equipment and processing clinic trays, that will
require space and additional resources.
The bottom line is that every
facility embarking upon an SPD redesign should be asking how they can design
the department in a way that will optimize staff performance in the most
productive and efficient way, stressed Barbara Trattler, RN, MPA, CNOR, CNA,
director of clinical education at
ASP. "Given [that] reprocessing requires
multiple steps that occur in various locations, the redesign is the
opportunity to streamline workflow and, ultimately, maximize the
productivity of staff."
And don’t forget to take a
closer look at how non-inventoried devices and instruments are processed,
either. According to Down, some may mistakenly overlook the impact of loaner
tray volume on departmental workflow, for example, and some may fail to
factor in the impact of manufacturer-recommended sterilization cycles
variances on the daily workload. "These oversights can cause workflow
challenges or bottlenecks once the department is running," he said.
Equally critical is that
C-level executives, architects, consultants, contractors, and others solicit
direct and ongoing feedback from the SPD during all planning and design
stages. Unfortunately, that doesn’t always happen. In fact, Gayden confirmed
that the extent of a sterile processing professional’s involvement often
begins and ends with their equipment preferences. And it’s a mistake that
can wind up costing hospitals dearly in the end.
As Duro explained, a design
must reflect guidelines and industry standards, such as those provided by
the Association for the Advancement of Medical Instrumentation, and no one
knows those standards better than the SPD staff who serve as the true
instrumentation and processing experts. Likewise, only the SPD team
understands what’s involved in the day to day operations of the department,
which is why they must have the primary say in layout, equipment location
and overall space planning.
"Letting architects run with a
design is a mistake. We as users need to have a say in what they are doing
and should collaborate to ensure the best design for the facility," Duro
explained. SPD involvement should also encompass site visits of neighboring
facilities. "If you have an opportunity to redesign or build new, some of
the great concepts for workflow and other efficiencies can be found at other
facilities."
Failure by SPD staff to
appreciate the importance of ongoing participation throughout the design and
construction process is another big oversight, stressed consultant Rose
Seavey, RN, BS, MBA, CNOR, CRCST, CSPDT, president and CEO of
Seavey
Healthcare Consulting LLC, and former SPD director at The Children’s
Hospital of Denver. "Never ever miss a construction meeting," she urged.
The
following photos showcase some of the new features in NEBH's redesigned SPD:
A busy afternoon on a
heavy joint day. Less lifting and manual interaction with washers enables
techs to prep instruments for the processes ahead.
Rotary turntable
automation with instruments cued to wash. Increased processing capacity.
New workstations,
enhanced lighting and extra space
enable more efficient processing.
A view from sterile
storage into processing.
Room to
grow
Another critical oversight that can occur during the redesign planning
process: failing to understand the importance of completing a remodel
without the need for a complete departmental shut-down. "Planners neglect to
bring this variable into the equation when laying out the new department,"
said Felipe Mejia of Belimed Inc.'s Project Planning Group. Further, he
reasoned, it's not uncommon for SPD managers to be informed after the
general layout is completed that the redesign can't be completed because the
initial drawings failed to show a detail that makes the site preparation
cost-prohibitive. "Or, after construction begins, the Facility group
realizes that project costs could have been reduced had the planners been
aware of the real existing conditions."
If there’s ever a common theme
in departmental redesign and planning it’s this: one can never have too much
space. In the side words of Seavey – who, over the course of her hospital
career, experienced three OR/SPD redesigns and was directly involved in a
five-year planning and building project of a brand new hospital from the
ground up – "whatever size you think you need now, you may want to double
it."
When space planning and
plotting for equipment and zone locations, facilities must not only ensure
adequate space to meet the services and volumes provided, they must also be
sure to incorporate a wide range of other critical factors, such as
infection control principles, ease of receiving, storing and dispensing of
supplies, waste disposal, soiled linen removal, and more. And don’t overlook
the importance of adequate team space, including a conference room or break
area, and sufficient office space, added Bruce T. Bird, CRCST, central
processing manager for Primary Children’s Medical Center in Salt Lake City,
UT.
Another oversight? "Not
providing adequate space for surplus and evaluation equipment and supplies,
as well as enough storage space for case carts throughout all areas in which
they travel," Bird explained, adding that it’s also essential to allocate
enough space to allow for customers and efficient workflow between the SPD
and OR.
Other design elements to
factor into early planning, reasoned Down, is where to best position pure
water and detergent closing systems for optimal workflow, and where to place
access for easiest maintenance and repair. Environmental factors, such as
air flow, temperature and humidity must also be planned into the design, he
said.
Top tips for
creating an SPD design that endures
Whether full-fledged, new
construction is in the cards or a facility’s plan calls for a
smaller, more budget conscious redesign, experts largely agree
that the same general rules apply: allocating efforts to create a
well-functioning, efficient and safety-focused SPD is a wise
decision. And the same goes for being diligent to ensure that
every dollar and design element is well-applied.
“If the OR is the heart of the
hospital then the [SPD] is the veins and arteries that feed it,”
said Douglas Gayden, business development director, central
region, Getinge USA. “If there’s a blockage in that department,
you’re going to have big problems. A good [SPD] design helps
ensure that things continue to run smoothly and efficiently, and
at the highest level of quality.”
Here vendor experts, consultants
and SPD managers offer some of their top tips for designing a
successful departmental design that endures – even on a shoestring
budget.
Q What, in your opinion,
should be the ultimate goal of an SPD redesign? What are
some
of the key steps facilities should prepare for in achieving such a
goal?
Meeting regulations, guidelines
and standards is critical, as is providing enough space for
volumes and services provided. Also important is having enough
equipment to allow those volumes and services to be provided,
creating a healthful and safe work environment for team members,
and providing support for productive, efficient processing.
~ Bruce T. Bird,
CRCST, central processing manager, Primary Children’s Medical
Center, Salt Lake City, UT
The ultimate goal is to ensure
that we have a department that can serve the hospital as best as
it can,and in doing this, focusing on the future to ensure that
newer technologies are being used. These newer technologies are at
our disposal – from tracking systems to automated processes and
solutions that improve worker safety through improved ergonomics
and design.
~ Mark Duro,
CRCST, FCS, central sterile processing manager, New England
Baptist Hospital
The ultimate goal is to prevent
infection. When allocating areas, placing equipment and fixtures,
and looking at flow, we have to continuously stop and ask, 'Is
this going to foster proper infection prevention practices? Is
this going to make it easier for the user to follow proper
procedure?' To understand this better, think about a hand wash
sink that is too far away; a door that makes it easy to go from
the Decontam Side to the Clean Side without an Ante area; a
pass-through window that's too far from the manual instrument wash
sink. a pass-through window that cannot be closed, challenging the
air pressure difference; or a loaner/vendor's room that everyone
has access to, etc. Facilities need to have a clear definition on
the right processes to prevent infection. Once that is clear, it
is easier to look at the design and ask, 'Are we designing so that
we can follow proper procedures?'
~ Felipe Mejia,
Project Planning Group, Belimed Inc.
The goal should be to increase
space for future growth, provide enough storage to not stack
sterile supplies, allow for close proximity to the OR, and ensure
that there are dedicated clean and dirty elevators. To help
achieve those goals, it’s important to know the recommended
practices, such as AAMI ST79, Section 3, Design Considerations;
have good negotiation skills; and partner with Infection
Prevention.
~ Rose Seavey,
RN, BS, MBA, CNOR, CRCST, CSPDT, president and CEO of Seavey
Healthcare Consulting LLC
Q
If budgets and/or space are particularly limited, what should
facilities consider to improve the overall efficiencies and
productivity in their existing SPD?
The most important tactic is to
make sure that existing equipment is functioning at original
equipment manufacturer specifications. Others would include:
decluttering the department, removing unnecessary carts/storage
areas, establishing standardized ergonomic workstations, and
properly aligning staffing.
~ Tracy Rapp,
director of staff development, IMS
[Poor] space allotment is a
mistake. We all know money is tight, but if you have a car in need
of a new engine it might be best to replace that engine and spend
the money upfront as opposed to making multiple fixes to it over
the next 15 years. The CSSD is the engine that keeps the OR
moving. Investing in the SPD will pay off over time, so we need to
ensure that space is available to meet all recommendations for
decontamination, processing and storage.
~ Mark Duro,
CRCST, FCS
If space is limited, think
outside the box. Look for wasted areas, think of equipment that
does not require extensive service areas. Hospitals with limited
budgets tend to forget the savings that better designed equipment
will yield due to the dramatic decrease in operational costs. For
example, a large sterilizer with an old venturi-type cooling
system can go through 800 gallons of water in just one cycle.
These are 800 gallons of water that the hospital will see on its
water and [sewage] bill every time they run a load. A new
sterilizer of the same instrument load capacity -- with the latest
technology that includes a sophisticated, very reliable vacuum
pump linked to the hospital's chilled water system -- will only
use three gallons of water per load. In addition, if this is a
stainless steel sterilizer hooked up to a clean steam generator
(steam from DI to RO water), then there will be no monthly cost in
cleaning the chamber because there will be no mineral deposits.
The heat exchangers will always be free of scaling, reducing
energy consumption due to an efficient heat transfer, and most
importantly, the need to frequently replace expensive instruments
due to pitting will be reduced. Another idea: look at modular
systems that can be expanded. If the hospital needs a bank of
washers with automation, but only has room for one, we suggest
that they buy one now and expand the system as they get more
money. Again, the system has to be modular, so that future
equipment can easily be added without interrupting the day-to-day
departmental operations.
~ Felipe Mejia,
Project Planning Group, Belimed Inc.
Better storage should be
considered. If [a facility] has wire carts, sometimes just
purchasing more shelves for the carts will help.
~ Rose Seavey,
RN, BS, MBA, CNOR, CRCST, CSPDT
Begin by identifying the issues
that are of greatest concern. It’s possible that the issue can be
corrected with training, staff realignment, process adjustments,
or other internal measures. These activities can often be
accomplished with minimal investment.
~ Patrick Down,
director, Project Design Group,
STERIS Corp.
When there are budget and space
limitations, facilities should focus on streamlining workflow and
improving efficiency and productivity. One way to do this is by
making updates to current processes. For example, ASP offers
SteriTite containers that can be used with the STERRAD system to
package instruments. These containers improve efficiency by
eliminating the need for wrapping and allowing you to package
devices for a single procedure together.
~ Barbara
Trattler, RN, MPA, CNOR, CNA,
director of clinical education, ASP
Invest smartly. Figure out a
roadmap and invest in things that provide immediate impact, such
as instrument and asset tracking systems. Also, when you work in
the department every day it’s easy to get comfortable with how
things work and function. Pretend you don’t work there and really
take a closer look at each step in the process to determine where
changes can be made. Some big changes can be made at low or no
cost.
~ Douglas Gayden,
business development director,
central region, Getinge USA
Equally prudent is carving out
ample space to accommodate future growth and equipment purchases that may be
on a facility’s wish list, but can’t yet be acquired due to limited budgets.
"Look to the future for new products, even though your budget may not allow
it now," said Seavey. "Plan for tomorrow."
Sources agreed that automation
and resource management solutions are worthwhile investments deserving of a
spot on the SPD redesign wish list. As Trattler explained, achieving optimal
workflow and utilization of automation to drive efficiency, productivity and
throughput should be at the core of any SPD redesign.
"Facilities make large
investments in their instrumentation and technology, so when redesigning
their SPD they should aim for a design that maximizes their workflow process
through automation and an innovative sterilization modality," she reasoned.
One way to accomplish this is through improving information management
within the facility. Positioning instructions for use at individual
workstations, so they are readily accessible as technicians are prepping
instruments for sterilization is one example, she said.
Assessing equipment based on future objectives, as opposed to existing
conditions, will go a long way toward maximizing return on investment. As
Mejia explained, an SPD manager who currently has a 15-year-old cart washer
with a 28-minute processing cycle, poor drying capabilities and weekly
breakdowns may seek two new cart washers A soiled-cart holding area on the
Decontamination side to hold many carts during peak periods may also be on
the wish list, along with a large dripping floor grate on the Clean side.
"Once the SPD manager realizes that there is a cart washer on the market
capable of processing three carts in less than seven minutes, and that this
cart washer will rarely break down with proper maintenance -- and will come
with a technology that produces bone-dry carts -- then the entire design of
the SPD area changes," he reasoned. "All of a sudden, two cart washers
become one, an extensive dirty cart holding area is reduced by 70 percent, a
large dripping area on the Clean side disappears, increasing the odds of
infection prevention, and FTEs can be better allocated."
Don’t forget to tap equipment
and solutions vendors as a collaborative partner throughout the process,
either – many of whom offer consulting services at low- or no-cost to their
hospital customers.
"Device reprocessing
manufacturers offer best practices and advice to ensure that technology is
used in the most efficient way," Trattler noted.
Mejia explained the value of asking equipment vendors some key questions
about the redesign planning, such as how they would fix the department given
a certain budget, space and objectives. "Too often, we are called in to
place equipment in a redesigned department that could have been much better,
but it is is [now] too late to fix," he said.
Of course, vendors also know
equipment’s electrical and plumbing requirements – two key factors that are
very costly and difficult to fix after the redesign is already underway.
Getinge’s Gayden said facilities must ensure that plumbing is designed in a
way that allows all washers to be operating and dumping water at the same
time. "Proper plumbing is critical because water can back up and force the
department to shut down," he warned.
Vendor involvement also
ensures that equipment connectivity issues will be adequately addressed.
"Most SPD equipment can now be hooked up to data management platforms or the
hospital’s internal network, so the department’s IT requirements must be
factored in," stressed Down of STERIS.
Ensuring that the department
has enough data ports, electrical outlets, drains and utilities for future
growth and expansion will all play a role in ensuring that the SPD can
function optimally in the months and years ahead, according to Seavey. She
further pointed out that design elements that address worker safety, such as
adjustable sinks and work stations, go a long way toward improving
productivity and overall efficiencies, while mitigating risks for staff
injuries.
In cases where broad-scale
redesigns aren’t feasible and facilities must work with existing floor plans
and space constraints, Bird said high-density storage solutions, streamlined
instrument sets, smaller-footprint and more efficient equipment, and
improved distribution of available space can help make the most of every
square foot.
"A well-designed space
is often better than a lot of space that’s poorly designed," he assured.
